Proof: the part of a recipe where dough is allowed to rise.

Twice, during the baking of bread, proof is required. Yeast is proofed in water and a small bit of sugar to make sure it’s still active before going any further in the recipe. But proofing also describes a step where the dough doubles in size, the moment when it suddenly grows in dynamic proportion to what you started out with.

What makes the dough rise? The yeast, which converts glucose and other carbohydrates into carbon dioxide gas. Different breads proof differently. Some require only a single proofing; others need many. Between these stages, the baker is told to punch down the dough.

It’s no surprise to me that—in baking, and in life—the cost of growth is always a small act of violence.

SUNDAY MORNING STICKY ROLLS

DOUGH

3¾ cups flour

1/3 cup sugar

1 teaspoon salt

2 packages active dry yeast

1 cup heated milk

1 egg

1/3 cup butter, softened

CARAMEL

¾ cup dark brown sugar

½ cup unsalted butter

¼ cup light corn syrup

¾ cup pecan halves

2 tablespoons butter, softened

FILLING

½ cup pecans, chopped

2 tablespoons sugar

2 tablespoons brown sugar

1 teaspoon cinnamon

You once told me that the best part of a lazy Sunday is to wake up and smell something so delicious you follow your nose downstairs. This is one of those recipes that, like most breads, requires you to be thinking ahead—but then again, when wasn’t I thinking ahead for you?

To make the dough, mix together 2 cups of the flour, 1/3 cup sugar, salt, and yeast in a large bowl. Add the heated milk, egg, and 1/3 cup butter, and beat at low speed for a minute. Add flour if necessary to make the dough easier to shape.

On a lightly floured surface, knead dough for 5 minutes. This, I will add, was your favorite part—you would stand on a chair and throw your weight into it. When finished, put the dough into a greased bowl and flip it over once, so the greased side faces up. Cover and let it proof until it doubles in size, about 1½ hours. It’s ready if you poke it and the mark of your finger is left behind.

Caramel comes next: Stirring constantly, heat ¾ cup brown sugar and ½ cup butter to boiling. Remove from the heat and add the corn syrup. Pour the mixture into a 13 by 9 by 2-inch ungreased pan. Sprinkle pecan halves over the mixture.

For the filling, mix together the chopped pecans, 2 tablespoons sugar, 2 tablespoons brown sugar, and cinnamon. Set aside.

Punch down the dough with your fist. Then, on a lightly floured surface, flatten it into a rectangle, about 15 by 10 inches. Spread it with 2 tablespoons of butter, then dust it evenly with the chopped pecan mixture. Beginning at the 10-inch side of the rectangle, roll the dough up tightly and pinch the edge closed. Roll it, stretch it, and mold it until it is cylindrical.

Cut into eight even slices and place them in a pan, not quite touching. Wrap the pan tightly with foil and refrigerate for at least 12 hours. Dream of them rising, that proof again, evidence that some things grow bigger than we ever expect.

Heat the oven to 350 degrees F and bake 35 minutes. When golden, remove from the oven. Immediately invert on a platter, and serve warm.

Marin

Minutes later

I’ve always sort of wondered about the term bearing witness. Is it that testifying is such a hardship? Or is it childbirth lingo, the idea that a witness brings forth something new to the trial? That’s certainly true, but not in the way you’d imagine. Witness testimony is always flawed. It’s better than circumstantial evidence, sure, but people aren’t camcorders; they don’t record every action and reaction, and the very act of remembering involves choosing words and phrases and images. In other words, every witness who’s supposed to be giving a court facts is really just giving them a version of fiction.

Charlotte O’Keefe, who was on the witness stand now, was not even really capable of bearing witness to her own life, in spite of the fact that she’d lived it. By her own admission, she was biased; by her own admission, she remembered her history only when it was entwined with Willow’s.

I would make a lousy witness, of course. I didn’t know where my story started.

Charlotte had knotted her hands in her lap and sailed through the first three questions:

What’s your name?

Where do you live?

How many children do you have?

She’d stumbled on the fourth question, though:

Are you married?

Technically, the answer to that was yes. But practically, it had to be spelled out—or Guy Booker would use Charlotte and Sean’s separation to his own legal advantage. I had coached Charlotte through the right response, and we had not managed to practice it yet without her bursting into tears. As I waited for her to answer, I found myself holding my breath.

“Right now I am,” Charlotte said evenly. “But having a child with so many special needs—it’s caused a lot of problems in my marriage. My husband and I are separated right now.” She exhaled, a slow whistle.

Good girl, I thought.

“Charlotte, can you tell us about how Willow was conceived?” At the gasp of an elderly juror, I added, “Not the nuts and bolts…more like the decision you made to become a parent.”

“I was already a parent,” Charlotte said. “I’d been a single mother for five years. When I met Sean, we both knew we wanted more children—but that didn’t seem to be in the cards. We tried to get pregnant for almost two years, and we were just about to start fertility treatments when, well, it just happened.”

“How did that feel?”

“We were ecstatic,” Charlotte replied. “You know how sometimes, your life is so perfect you’re afraid for the next moment, because it couldn’t possibly be quite as good? That’s what it felt like.”

“How old were you when you became pregnant?”

“Thirty-eight.” Charlotte smiled a little. “A geriatric pregnancy, they call it.”

“Were you concerned about that?”

“I knew that the odds of having a Down syndrome child were higher once you were over thirty-five.”

I approached the stand. “Did you speak to your obstetrician about that?”

“Yes.”

“Can you tell the court who your obstetrician was at the time?”

“Piper Reece,” Charlotte said. “The defendant.”

“How did you select the defendant as your ob-gyn?”

Charlotte looked down at her lap. “She was my best friend. I trusted her.”

“What did the defendant do to address your concerns about having a baby with Down syndrome?”

“She recommended that I do some blood tests—a quad screen, it was called—to see if I had an even greater chance than the norm to have a baby with neural defects, or Down syndrome. Instead of my risk being one in two hundred and seventy, it was one in one hundred and fifty.”

“What did she recommend?” I asked.

“Amniocentesis,” Charlotte replied, “but I knew that carried a risk, too. Since I was scheduled to have a routine ultrasound anyway at eighteen weeks, she said we could read the results of that first, then make a decision about the amnio based on what we saw. It wasn’t as accurate as amnio, but there were supposedly certain things that might turn up that would suggest Down syndrome, or rule it out as less likely.”

“Do you remember that ultrasound?” I asked.

Charlotte nodded. “We were so excited to see our baby. And at the same time, I was nervous—because I knew the technician was going to be looking for those Down syndrome markers. I kept watching her, for clues. And at one point she tipped her head and said, ‘Hmm.’ But when I asked her what she’d seen, she told me that Dr. Reece would read the results.”

“What did the defendant tell you?”

“Piper came into the room, and I knew, just from her face, that the baby didn’t have Down syndrome. I asked her if she was sure, and she said yes—that the technician had even remarked on how clear the images were. I made her look me in the eye and tell me that everything looked all right—and she said that there was only one measurement that was the slightest bit off, a femur that was in the sixth percentile. Piper said that wasn’t something to worry about, since I was short, that by the next ultrasound, that same measurement could be up in the fiftieth percentile.”

“Were you concerned about the sonogram images being clear?”

“Why would I be?” Charlotte said. “Piper didn’t seem to be, and I assumed that was the whole point of an ultrasound—to get a good picture.”

“Did Dr. Reece advise having a more detailed follow-up ultrasound?”

“No.”

“Did you have any other ultrasounds during your pregnancy?”

“Yes, when I was twenty-seven weeks pregnant. It wasn’t a test as much as a lark—we did it after-hours in her office, to find out the sex of the baby.”

I faced the jury. “Do you remember that ultrasound, Charlotte?”

“Yes,” she said softly. “I’ll never forget it. I was lying on the table, and Piper had the wand on my belly. She was staring at the computer screen. I asked her when I’d get a chance to look, but she didn’t answer. I asked her if she was okay.”

“What was her response?”

Charlotte’s eyes looked across the room and locked with Piper’s. “That she was okay. But that my daughter wasn’t.”

Charlotte

“What are you talking about? What’s the matter?” I’d sat up on my elbows, looking at the screen, trying to make sense of the images as they jostled with my movements.

Piper pointed to a black line that looked to me like all the other black lines on the screen. “She’s got broken bones, Charlotte. A bunch of them.”

I shook my head. How could that be? I had not fallen.

“I’ll call Gianna Del Sol. She’s the head of maternal-fetal medicine at the hospital; she can explain it in more detail—”

“Explain what?” I cried, riding the high wire of panic.

Piper pulled the transducer away from my belly, so that the screen went clear. “If it’s what I think it is—osteogenesis imperfecta—it’s really rare. I’ve only read about it, during medical school. I’ve never seen a patient who has it,” she said. “It affects collagen levels, so that bones break easily.”

“But the baby,” I said. “It’s going to be okay, right?”

This was the part where my best friend embraced me and said, Yes, of course, don’t be silly. This was the part where Piper told me it was the kind of problem that, ten years from now, we’d laugh about at your birthday party. Except Piper didn’t say any of that. “I don’t know,” she admitted. “I honestly don’t know.”

We left my car at Piper’s office and drove back to the house to tell Sean. The whole way, I ran a loop of memory in my mind, trying to think back to when these breaks might have happened—at the restaurant, when I’d dropped that stick of butter and bent down to retrieve it? In Amelia’s room, when I stumbled over a tangled pair of pajama pants? On the highway when I stopped short, so the seat belt tightened against my belly?

I sat at the kitchen table while Piper told Sean what she knew—and what she didn’t. From time to time, I could feel you inside me, rolling a slow tango. I was afraid to touch my hands to my abdomen, and acknowledge you. For seven months we had been a unit—integrated and inseparable—but right now, you felt alien to me. Sometimes in the shower when I did a self–breast exam I had wondered what I would do if I were diagnosed—chemo, radiation, surgery?—and I had decided that I would want the tumor cut out of me right away, that I couldn’t bear sleeping at night and knowing it was growing beneath my skin. You—who had been so precious to me hours ago—suddenly felt that way: unfamiliar, upsetting, other.

After Piper left, Sean became a man of action. “We’ll find the best doctors,” he vowed. “We’ll do whatever it takes.”

But what if there was nothing that could be done?

I watched Sean in his feverish zeal. Me, I was swimming through syrup, viscous and pendulous. I could barely move, much less take charge. You, who had once brought Sean and me so close together, were now the spotlight that illuminated how different we were.

That night, I couldn’t fall asleep. I stared at the ceiling until the red flush from the LED numbers on the clock radio spread like wildfire; I counted backward, from this moment to the one where you were conceived. When Sean got out of bed quietly, I pretended that I was asleep, but that was only because I knew where he was headed: to look up osteogenesis imperfecta on the Internet. I’d thought about doing that, too, but I wasn’t as brave as he was. Or maybe I was less naïve: unlike him, I believed what we learned could actually be worse than what we already knew.

Eventually, I did drift off. I dreamed that my water had broken, that I was having contractions. I tried to roll over to tell Sean, but I couldn’t. I couldn’t move at all. My arms, my legs, my jaw; somehow I knew that I was broken beyond repair. And somehow I knew that whatever had been inside me all these months had liquefied, was soaking into the sheets beneath me, was no longer a baby at all.

The next day was a whirlwind: from a high-level ultrasound, at which even I could see the breaks, to a meeting with Gianna Del Sol to discuss the findings. She threw out terms that meant nothing at the time: Type II, Type III. Rodding. Macrocephaly. She told us that one other child with OI had been born at this hospital, years earlier, who’d had ten breaks—and who had died within an hour.

Then she sent us to a geneticist, Dr. Bowles. “So,” he said, getting right down to business—no I’m so sorry you had to hear this news. “The best-case scenario here,” he said, “would be a baby that survives the birth, but even if that’s the case, a Type III might have cerebral hemorrhage caused by birth trauma or an increased circumference of the head compared to the rest of the body. She will most likely develop severe scoliosis, have surgeries for multiple broken bones, need rodding in her spine, or vertebrae fused together. The shape of her rib cage won’t allow her lungs to grow, which can lead to repeated respiratory infections, or even death.”

Amazingly, this was a whole different run of symptoms from the ones Dr. Del Sol had given us already.

“And of course, we’re talking hundreds of broken bones, and realistically a very good chance she’ll never walk. Basically,” the geneticist said, “what you’re looking at is a lifetime, however short, of pain.”

I could feel Sean next to me, coiled like a cobra, ready to take out his own anger and grief on this man, who was talking to us as if it were not you, our daughter, who was the subject but a car whose oil we needed to change.

Dr. Bowles looked at his watch. “Any questions?”

“Yes,” I said. “Why didn’t anyone tell us before?”

I thought of all the blood tests I’d taken, the earlier ultrasound. Surely if my baby was going to be this sick—this hurt for her whole life—something would have shown up earlier?

“Well,” said the geneticist, “neither you nor your wife is a genetic carrier of OI, so it wouldn’t have been routinely tested for prior to conception, or flagged by the obstetrician as something to keep an eye on. It’s good news, actually, that the disease was a spontaneous mutation.”

My baby is a mutant, I thought. Six eyes. Antennae. Take me to your leader.

“If you have another child, there’s no reason to believe this will happen again,” he said.

Sean came out of his seat, but I put a hand on his arm to restrain him.

“How do we know whether the baby will…” I couldn’t say it. I lowered my eyes, so that he knew what I meant. “…at birth, or live longer?”

“It’s very difficult to tell at this point,” Dr. Bowles said. “We’ll schedule repeated ultrasounds, of course, but sometimes a parent whose child has a lethal prognosis will end up with a baby that survives, or vice versa.” He hesitated. “There is another option—several places in this country will terminate a pregnancy for maternal or fetal medical reasons, even this far along.”

I watched Sean fit his teeth around the word he did not want to say out loud. “We don’t want an abortion.”

The geneticist nodded.

“How?” I asked.

Sean stared at me, horrified. “Charlotte, do you know about those things? I’ve seen pictures—”

“There are many different methods,” Bowles answered, looking directly at me. “Intact D and E is one, but so is induction after stopping the fetus’s heart.”

“Fetus?” Sean said, exploding. “That’s not a fetus. That’s my daughter we’re talking about.”

“If termination isn’t an option—”

“Option? Fuck that. It should never even have been on the table,” Sean said. He reached for me, pulling me to my feet. “Do you think Stephen Hawking’s mother had to listen to this load of bullshit?”

My heart was hammering and I could not catch my breath. I didn’t know where Sean was taking me, and I didn’t particularly care. I just knew that I couldn’t listen to that doctor for one more moment, talking about your life or lack thereof as if it were a textbook he was reading on the Holocaust, the Inquisition, Darfur: truths that were so awful and graphic that you instead skipped over them, conceding their horror without suffering the details.

Sean dragged me down the hallway and into an elevator that was just closing. “I’m sorry,” he said, leaning against the wall. “I just…I couldn’t.”

We were not alone inside. To my right was a woman about ten years older than I was, pushing one of those state-of-the-art wheelchairs with a child sprawled across it. This one was a boy in his teens, thin and angular, his head supported by a brace on the back of the chair. His elbows twisted, so that his arms were flailed outward; his glasses were askew on the bridge of his nose. His mouth was open, and his tongue—thick and jellied—filled the bowl of his mouth. “Aaaaah,” the boy sang. “Aaaaah!”

His mother touched her hand to his cheek. “Yes, that’s right.”

I wondered if she really understood what he was trying to say. Was there a language of loss? Did everyone who suffered speak a different dialect?

I found myself staring at the woman’s fingers, stroking her son’s hair. Did this boy know his mother’s touch? Did he smile at her? Would he ever say her name?

Would you?

Sean reached for my hand and squeezed it tightly. “We can do this,” he whispered. “We can do it together.”

I didn’t speak until the elevator stopped at floor three and the woman pushed her son’s wheelchair off into the hallway. The doors sealed shut again, isolating Sean and me in a vacuum. “Okay,” I said.

“Tell us about Willow’s birth,” Marin said, pulling me back to the present.

“She was early. Dr. Del Sol had scheduled a C-section, but instead, I went into labor and everything happened very quickly. When she was born, she was screaming, and they took her away from me to X-ray her, to do tests. It was hours before I saw Willow, and when I did, she was lying on a foam pad in a bassinet, with bandages wrapped around her arms and legs. She had seven healing fractures and four new breaks caused by the birth.”

“Did anything else happen in the hospital?”

“Yes, Willow broke a rib, and it pierced her lung. It was…it was the most frightening thing I’ve ever seen in my life. She went blue, and suddenly there were dozens of doctors in the room and they started doing CPR and stuck a needle in between her ribs. They told me her chest cavity had filled with air, which made her heart and trachea shift to the wrong side of her body, and then her heart had stopped beating. They did chest compressions—breaking even more of her ribs—and put in a chest tube to make the organs go back where they belonged. They cut her,” I said. “While I watched.”

“Did you talk to the defendant afterward?” Marin asked.

I nodded. “Another doctor told me that Willow had been without oxygen for a while, and that we wouldn’t know if there would be brain damage. He suggested that I sign a DNR form.”

“What’s that?”

“It means do not resuscitate. If anything like this happened to Willow again, the doctors wouldn’t intervene. They’d let Willow die.” I looked into my lap. “I asked Piper for advice.”

“Because she was your physician?”

“No,” I said. “Because she was my friend.”

Piper

I had failed.

That’s what I thought, when I looked down at you, battered and buttressed, a fountain of a chest tube blooming out from beneath your fifth rib on the left side. I had been asked by my best friend to help her conceive, and this was the outcome. After the wrenching question about whether or not you belonged in this world, it seemed that you were giving Charlotte your own answer. Without saying a word, I walked up to Charlotte, who was staring down at you as you slept, as if glancing away for even a moment might give you incentive to code again.

I had read your chart. The fractured rib had caused an expanding pneumothorax, a mediastinal shift, and cardiopulmonary arrest. The resultant intervention had caused nine further fractures. The chest tube had been inserted through the fascia and into the pleural space of your chest, sutured into place. You looked like a battlefield; the war had been fought on the broken ground of your tiny body.

Without saying a word, I walked up to Charlotte and reached for her hand. “Are you okay?” I asked.

“I’m not the one you need to worry about,” she replied. Her eyes were red-rimmed; her hospital robe askew. “They asked if we wanted to sign a DNR.”

“Who asked that?” I had never heard of anything so stupid. Not even Terri Schiavo had been made DNR until tests indicated severe, irreversible brain damage. It was hard enough to get a pediatrician to be hands off when dealing with a severely preterm fetus with a high probability of death or lifetime morbidity—to suggest a DNR for a neonate on whom they’d just done the full-court press in terms of a code seemed improbable and impossible.

“Dr. Rhodes—”

“He’s a resident,” I said, because that explained everything. Rhodes barely knew how to tie his shoes, much less talk to a parent who’d been through an intense trauma with a child. Rhodes should never have brought up the DNR to Charlotte and Sean—particularly since Willow hadn’t yet been tested to see if she was mens sana. In fact, while he was ordering that test, he might have wanted to get one for himself.

“They cut her open in front of me. I heard her ribs break when they…when they…” Charlotte’s face was white, haunted. “Would you sign one?” she whispered.

She had asked me the same question, in not so many words, before you were even born. It was the day after her twenty-seven-week ultrasound, when I had sent her to Gianna Del Sol and the health-care team for high-risk pregnancies at the hospital. I was a good obstetrician, but I knew my limits—and I couldn’t provide her with the care she now needed. However, Charlotte had been traumatized by a stupid geneticist whose bedside manner was better suited to patients already in the morgue, and now I was doing damage control while she sobbed on my couch.

“I don’t want her to suffer,” Charlotte said.

I did not know how to tiptoe around the topic of a late-term abortion. Even someone who wasn’t Catholic, like Charlotte, would have a hard time swallowing that option—and yet, it was never chosen lightly. Intact D & Es were performed only by a handful of physicians in the country, physicians who were highly skilled and committed to ending pregnancies where there was a great maternal or fetal health risk. For certain conditions that weren’t apparent before the twelve-week cutoff for abortions, these doctors provided an alternative to giving birth to a baby with no chance of survival. You could argue that either outcome would leave a scar on the parent, but then again, as Charlotte had pointed out, there were no happy endings here.

“I don’t want you to suffer,” I replied.

“Sean doesn’t want to do it.”

“Sean isn’t pregnant.”

Charlotte turned away. “How do you fly across the country with a baby inside you, knowing you’ll be coming back without one?”

“If it’s what you want, I’ll go with you.”

“I don’t know,” she sobbed. “I don’t know what I want.” She looked up at me. “What would you do?”

Two months later, we stood on opposite sides of your hospital NICU bassinet. The room, filled with so many machines to keep their tiny charges alive and functional, was bathed in a rich blue light, as if we were all swimming underwater. “Would you sign one?” Charlotte asked me again, when I didn’t answer the first time.

You could argue that it was less traumatizing to terminate a pregnancy than it was to sign a DNR for a child who was already in this world. Had Charlotte made the decision to terminate at twenty-seven weeks, her loss would have been devastating but theoretical—she would not have met you yet. Now, she was forced to question your existence again—but this time, she could see the pain and suffering in front of her eyes.

Charlotte had come to me for advice multiple times: about conceiving, about whether or not to have a late-term abortion, and now, about a do not resuscitate order.

What would I do?

I would go back to the moment Charlotte had asked me to help her have a baby, and I’d refer her to someone else.

I’d go back to when we were more likely to laugh together than to cry.

I’d go back to the time before you had come between us.

I’d do whatever I had to, to keep you from feeling like everything was breaking apart.

If you chose to stop a loved one’s suffering—either before it began or during the process—was that murder, or mercy?

“Yes,” I whispered. “I would.”

Marin

“The learning curve was huge,” Charlotte said. “From figuring out how to hold Willow, or how to change her diaper without breaking a bone, to knowing that we might simply be carrying her in our arms and hear that little pop that meant she’d broken something. We found out where to order car beds and adapted infant carriers, so that the straps wouldn’t snap her collarbones. We started to understand when we had to go to the emergency room and when we could splint the break ourselves. We stocked our own waterproof casts in the garage. We traveled to Nebraska, because they had orthopedic surgeons who specialized in OI, and we started Willow on a course of pamidronate infusions at Children’s Hospital in Boston.”

“Do you ever—well, for lack of a better term—get a break?”

Charlotte smiled a little. “Not really. We don’t make plans. We don’t bother, because we never know what’s going to happen. There’s always a new trauma we have to learn to deal with. Breaking a rib, for example, isn’t like breaking your back.” She hesitated. “Willow did that last year.”

Someone in the jury sucked in their breath, a whistling sound that made Guy Booker roll his eyes and that absolutely delighted me. “Can you tell the court how you’ve managed to pay for all this?”

“That’s a huge problem,” Charlotte said. “I used to work, but after Willow was born, I couldn’t. Even when she was in preschool, I had to be ready to run if she had a break, and you can’t do that when you’re the head pastry chef at a restaurant. We tried to hire a nurse that we trusted to take care of her, but it cost more than my salary, and sometimes the agency would send along women who knew nothing about OI, who didn’t speak English, who couldn’t understand what I told them about taking care of Willow. I had to be her advocate, and I had to be there all the time.” She shrugged. “We don’t give big birthday or Christmas gifts. We don’t have IRAs or a college fund for the kids. We don’t take vacations. All of our money goes to pay for what insurance doesn’t.”

“Like?”

“Willow’s in a clinical study for her pamidronate, which means it’s free, but once she’s a certain age she can’t be part of the study anymore, and each infusion is over a thousand dollars. Leg braces cost five thousand dollars each, rodding surgeries are a hundred thousand. A spinal fusion, which Willow will have to have as a teen, can be several times that, and that’s not counting the flight to Omaha to have it done. Even if insurance pays for part of these things, the rest is left to us. And there are plenty of smaller items that add up: wheelchair maintenance, sheepskin to line casts, ice packs, clothes that can accommodate casts, different pillows to make Willow more comfortable, ramps for handicapped access into the house. She’ll need more equipment as she gets older—reachers and mirrors and other adaptations for short stature. Even a car with pedals that are easier to press down on, so they don’t cause microfractures in her feet, costs tens of thousands of dollars to get rigged correctly, and Vocational Rehabilitation will pay for only one vehicle—the rest are your responsibility, for life. She can go to college, but even that will cost more than usual, because of the adaptations necessary—and the best schools for kids like Willow aren’t nearby either, which means more travel expenses. We cashed out my husband’s 401(k) and took out a second mortgage. I’ve maxed out two credit cards.” Charlotte looked over at the jury. “I know what I look like to all of you. I know you think I’m in this for a big payday, that this is why I started this lawsuit.”

I stilled, not sure what she was doing; this was not what we had practiced. “Charlotte, have you—”

“Please,” she said. “Let me finish. It is about cost. But not the financial kind.” She blinked back tears. “I don’t sleep at night. I feel guilty when I laugh at a joke on TV. I watch little girls the same age as Willow at the playground, and I hate them sometimes—that’s how bitterly jealous I can get when I see how easy it is for them. But the day I signed that DNR in the hospital, I made a promise to my daughter. I said, If you fight, I will, too. If you live, I will make sure your life is the best it can possibly be. That’s what a good mother does, right?” She shook her head. “The way it usually works, the parent takes care of the child, until years later, when the roles are reversed. But with Willow and me, I’ll always be the one taking care of her. That’s why I’m here today. That’s what I want you to tell me. How am I supposed to take care of my daughter after I’m gone?”

You could have heard a pin drop, a heart beat. “Your Honor,” I said. “Nothing further.”

Sean

The sea was a monster, black and angry. You were equally terrified and fascinated by it; you’d beg to go watch the waves crash against the retaining wall, but every time they did, you shivered in my arms.

I had taken the day off work because Guy Booker had said that all witnesses had to come to the trial on the first day. But as it turned out, I couldn’t be in the courtroom anyway, until my testimony. I stayed for ten minutes—just long enough for the judge to tell me to leave.

This morning, I’d realized that Charlotte thought I was coming to court to support her. I could see why, after the night before, she would expect that. In her arms, I had been explosive, enraged, and tender by turns—as if we were playing out our feelings in a pantomime beneath the sheets. I knew she was upset when I told her I was meeting Guy Booker, but she should have understood better than anyone why I still needed to testify against her in this lawsuit: you did what you had to do to protect your child.

After leaving the courthouse, I’d driven home and told the hired nurse to take the afternoon off. Amelia would need to be picked up at school at three, but in the meantime, I asked what you wanted to do. “I can’t do anything,” you said. “Look at me.”

It was true, your entire left leg was splinted. But all the same, I didn’t see why I couldn’t get a little creative to boost your spirits. I carried you out to the car, wrapped in blankets, and tucked you sideways across the backseat so that your leg was stretched along it. You could still wear your seat belt this way, and as you began to spot the familiar landmarks that led to the ocean, you got more and more animated.

There was nobody at the beach in late September, so I could park sideways across the lot that butted up to the retaining wall, giving you a bird’s-eye view. The truck’s cab sat high enough for you to see the waves, creeping forward and slinking backward like great gray cats. “Daddy?” you asked. “How come you can’t skate on the ocean?”

“I guess you can, way up in the Arctic, but for the most part, there’s too much salt in the water for it to freeze.”

“If it did freeze, wouldn’t it be awesome if there were still waves? Like ice sculptures?”

“That would be cool,” I agreed. I glanced over my headrest at you. “Wills? You okay?”

“My leg doesn’t hurt.”

“I wasn’t talking about your leg. I was talking about what’s going on today.”

“There were a lot of TV cameras this morning.”

“Yeah.”

“Cameras make my stomach hurt.”

I threaded my arm around the seat to reach your hand. “You know I’d never let any of those reporters bother you.”

“Mom should bake for them. If they really loved her brownies or her toffee bars, they might just say thank you and leave.”

“Maybe your mom could add arsenic to the batter,” I mused.

“What?”

“Nothing.” I shook my head. “Your mom loves you, too. You know that, right?”

Outside, the Atlantic reached a crescendo. “I think there are two different oceans—the one that plays with you in the summer, and the one that gets so mad in the winter,” you said. “It’s hard to remember what the other one’s like.”

I opened my mouth, thinking that you hadn’t heard what I said about Charlotte. And then I realized that you had.

Charlotte

Guy Booker was just the sort of person that Piper and I would have laughed at if we’d come across him at Maxie’s Pad—an attorney who had gotten so big in his own head that he had a personalized license plate which read HOTSHOT on his mint green T-Bird. “This is really about the money, isn’t it?” he said.

“No. But the money means the difference between good care and lousy care for my daughter.”

“Willow receives Katie Beckett monies through Healthy Kids Gold, doesn’t she?”

“Yes, but even so, that doesn’t cover all the medical expenses—and none of the out-of-pocket ones. For example, when a child’s in a spica cast, she needs a different kind of car seat. And the dental problems that are part and parcel of OI might run thousands of dollars a year.”

“If your daughter had been born a gifted pianist, would you be asking for money for a grand piano?” Booker said.

Marin had told me that he would try to get me angry, so that the jury would like me less. I took a deep breath and counted to five. “That’s comparing apples and oranges, Mr. Booker. This isn’t an arts education we’re talking about. It’s my daughter’s life.”

Booker walked toward the jury; I had to suppress an urge to check if he left a trail of oil. “You and your husband don’t see eye to eye about this lawsuit, Ms. O’Keefe, correct?”

“No, we do not.”

“Would you agree that the cause of your pending divorce is that your husband, Sean, doesn’t support this lawsuit?”

“Yes,” I said softly.

“He doesn’t believe Willow was a wrongful birth, does he?”

“Objection,” Marin called out. “You can’t ask her what his opinion is.”

“Sustained.”

Booker folded his arms. “Yet, you’re going through with the lawsuit anyway, even though it will most likely split up your family, aren’t you?”

I pictured Sean in his coat and tie this morning, that tiny lift of spirit I’d had when I thought he was coming to court with me instead of against me. “I still think it’s the right thing to do.”

“Have you had conversations with Willow about this lawsuit?” Booker asked.

“Yes,” I said. “She knows I’m doing this because I love her.”

“You think she understands that?”

I hesitated. “She’s only six. I think a lot of the mechanics of the lawsuit have gone over her head.”

“What about when she’s older?” said Booker. “I bet Willow’s pretty good when it comes to computer skills?”

“Sure.”

“Have you ever thought about the moment years from now when your daughter gets on the Internet and Googles herself? You? This case?”

“Well, God knows I’m not looking forward to that, but I hope that, if it happens, I’ll be able to explain to her why it was necessary…and that the quality of her life that day is a direct result of the lawsuit.”

“God knows,” Booker repeated. “Interesting choice of words. You’re a practicing Catholic, aren’t you?”

“Yes.”

“As a practicing Catholic, you’re aware that it’s a mortal sin to have an abortion?”

I swallowed. “Yes, I am.”

“Yet the premise of this lawsuit is that, if you’d known about Willow’s condition earlier, you would have terminated the pregnancy, right?”

I could feel the eyes of the jury on me. I had known that there was a point where I would be put on display—the sideshow oddity, the zoo animal—and this was it. “I know what you’re doing,” I said tightly. “But this case is about malpractice, not abortion.”

“That’s not an answer, Ms. O’Keefe. Let’s try again: if you’d found out that you were carrying a child who was profoundly deaf and blind, would you have terminated the pregnancy?”

“Objection,” Marin cried. “That’s irrelevant. My client’s child isn’t deaf and blind.”

“It goes to the mind-set of whether or not the child’s mother could have done what she says she could,” Booker argued.

“Sidebar,” Marin said, and they both approached the bench, continuing to argue loudly in front of everyone. “Judge, this is prejudicial. He can ask what my client’s decision was regarding actual medical facts that the defendant did not share with her—”

“Don’t tell me how to try my case, sweetheart,” Booker said.

“You arrogant pig—”

“I’m going to allow the question,” the judge said slowly. “I think we all need to hear what Mrs. O’Keefe has to say.”

Marin gave me a measured look as she walked past the witness stand—a reminder that I had been called to the mat, and was expected to deliver. “Ms. O’Keefe,” Booker repeated, “would you have aborted a profoundly deaf and blind child?”

“I…I don’t know,” I said.

“Are you aware that Helen Keller was profoundly blind and deaf?” he asked. “What if you found out that the baby you were carrying was missing a hand? Would you have terminated that pregnancy?”

I kept my lips pressed tight, silent.

“Are you aware that Jim Abbott, a one-handed pitcher, pitched a no-hitter in major league baseball and won an Olympic gold medal in 1988?” Booker said.

“I’m not Jim Abbott’s mother. Or Helen Keller’s. I don’t know how difficult their childhoods were.”

“Well, then, we’re back to the original question: If you had known about Willow’s condition at eighteen weeks, would you have aborted her?”

“I was never given that option,” I said tightly.

“Actually, you were,” Booker countered. “At twenty-seven weeks. And by your own testimony, it wasn’t a decision you could make then. So why should a jury believe that you would have been able to make it several weeks earlier?”

Malpractice, Marin had drilled into my head, over and over. That’s why you instigated this lawsuit. No matter what else Guy Booker claims, it’s about a standard of care and a choice you weren’t offered.

I was shaking so hard that I slipped my hands beneath my thighs. “This case isn’t about what I might have done.”

“Sure it is,” Booker said. “Otherwise, it’s a waste of our time.”

“You’re wrong. This case is about what my doctor didn’t do—”

“Answer the question, Ms. O’Keefe—”

“Specifically,” I said, “she didn’t give me a choice about ending the pregnancy. She should have known something was wrong from that very first ultrasound, and she should have—”

“Ms. O’Keefe,” the lawyer yelled, “answer the question!”

I wilted against the chair and pressed my fingers to my temples. “I can’t,” I whispered. I looked down at the grain of the wood on the railing before me. “I can’t answer that question for you now, because now there is a Willow. A girl who likes pigtails but not braids, and who broke her femur this weekend, and who sleeps with a stuffed pig. A girl who’s kept me awake at night for the past six and a half years wondering how to get through the next day without an emergency, and planning, as a backup, how to go from crisis to crisis to crisis.” I looked up at the lawyer. “At eighteen weeks of pregnancy, at twenty-seven weeks of pregnancy, I didn’t know Willow like I do today. So I can’t answer your question now, Mr. Booker. But the reality is, nobody gave me a chance to answer it back then.”

“Ms. O’Keefe,” the lawyer said flatly. “I’m going to ask you one last time. Would you have aborted your daughter?”

I opened my mouth, and then I closed it.

“Nothing further,” he said.

Amelia

That night, I ate dinner alone with my parents. You were sitting on the living room couch with a tray and Jeopardy! so that your leg could stay elevated. From the kitchen, I could hear the buzzer every now and then, and Alex Trebek’s voice: Ooh, I’m sorry, that’s incorrect. As if he really gave a damn.

I sat between my mother and father, a conduit between two separate circuits. Amelia, can you pass the green beans to your mother? Amelia, pour your father a glass of lemonade. They weren’t talking to each other, and they weren’t eating—none of us were, really. “So,” I said cheerfully. “During fourth period, Jeff Congrew ordered a pizza into French class and the teacher didn’t even notice.”

“Are you going to tell me what happened today?” my father asked.

My mother lowered her eyes. “I really do not want to talk about it, Sean. It was bad enough getting through it.”

The silence was a blanket so huge, it seemed to cover the entire table. “Domino’s delivered,” I said.

My father cut two precise squares of his chicken. “Well, if you won’t tell me what happened, I guess I’ll be able to read all about it tomorrow in the paper. Or maybe, hey, it’ll be on the eleven o’clock news…”

My mother’s fork clattered against her plate. “Do you think this is easy for me?”

“Do you think this is easy for any of us?”

“How could you?” my mother exploded. “How could you act like everything was getting better between us and then…then this?”

“The difference between you and me, Charlotte, is that I’m never acting.”

“It was pepperoni,” I announced.

They both turned to me. “What?” my father said.

“It’s not important,” I muttered. Like me.

You called out from the living room. “Mom, I’m done.”

So was I. I got up and scraped the contents of my plate, which was everything, into the trash. “Amelia, aren’t you forgetting to ask something?” my mother said.

I stared at her dully. There were a thousand questions, sure, but I didn’t want to hear the answers to any of them.

“May I be excused?” my mother prompted.

“Shouldn’t you be asking Willow that?” I said sarcastically.

As I passed you in the living room, you glanced up. “Did Mom hear me?”

“Not by a long shot,” I said, and I ran up the stairs.

What was wrong with me? I had a decent life. I was healthy. I wasn’t starving or maimed by a land mine or orphaned. Yet somehow, it wasn’t enough. I had a hole in me, and everything I took for granted slipped through it like sand.

I felt like I had swallowed yeast, like whatever evil was festering inside me had doubled in size. In the bathroom, I tried to throw up, but I hadn’t eaten enough at dinner. I wanted to run barefoot till my feet bled; I wanted to scream, but I’d been silent for so long that I’d forgotten how.

I wanted to cut.

But.

I had promised.

I took the telephone handset off its cradle beside my mother’s bed and carried it into the bathroom for privacy, since any minute now, you would hobble upstairs to get ready for bed. I had programmed Adam’s number in. We hadn’t spoken in a few days, because he’d broken his leg and had surgery—he’d IMed me from the hospital—but I was hoping he was home now. I needed him to be home now.

He had given me his cell number—I was surely the only kid over age thirteen who didn’t have one, but we couldn’t afford it. It rang twice, and then I heard his voice, and I nearly burst into tears. “Hey,” he said, “I was just going to call you.”

It was proof that there was someone in this world who thought I mattered. I felt like I’d just been pulled back from a cliff. “Great minds think alike.”

“Yeah,” he said, but his voice sounded thin and distant.

I tried to remember how he had tasted. I hated that I had to pretend I knew, when in reality, it had already faded, like a rose you press into a dictionary under the Qs, hoping you can call back summer at any time, but then in December it’s nothing more than crumbling, brown bits of dried flower. Sometimes at night I’d whisper to myself, pretending that the words came out in the low, soft curve of Adam’s voice: I love you, Amelia. You’re the one for me. And then I’d open my lips the tiniest bit and pretend that he was a ghost, and that I could feel him sinking into me, onto my tongue, down my throat, into my belly, the only meal that could fill me.

“How’s the leg?”

“Hurts like hell,” Adam said.

I curled the phone closer. “I really miss you. It’s crazy here. The trial started, and there were reporters all over the front lawn. My parents are certifiable, I swear—”

“Amelia.” The word sounded like a ball being dropped from the Empire State Building. “I wanted to talk to you because, um, this isn’t working out. This long-distance thing—”

I felt a pang between my ribs. “Don’t.”

“Don’t what?”

“Don’t say it,” I whispered.

“I just…I mean, we might never even see each other again.”

I felt a hook snag at the bottom of my heart, drawing it down. “I could come visit,” I said, my voice small.

“Yeah, and then what? Push me around in a wheelchair? Like I’m some kind of charity case?”

“I would never—”

“Just go get yourself some football player—that’s what girls like you want, right? Not some guy who bumps into a fucking table and snaps his leg in half—”

By now I was crying. “That doesn’t matter—”

“Yes it does, Amelia. But you don’t understand. You’ll never understand. Having a sister who’s got OI doesn’t make you an expert.”

My face was flaming. I hung up the phone before Adam could say anything else and held my palms to my cheeks. “But I love you,” I said, although I knew he couldn’t hear me.

First the tears came. Then the fury: I picked up the phone and hurled it against the bathtub wall. I grabbed the shower curtain and pulled it down in one good yank.

But I wasn’t mad at Adam; I was angry at myself.

It was one thing to make a mistake; it was another thing to keep making it. I knew what happened when you let yourself get close to someone, when you started to believe they loved you: you’d be disappointed. Depend on someone, and you might as well admit you’re going to be crushed, because when you really needed them, they wouldn’t be there. Either that, or you’d confide in them and you added to their problems. All you ever really had was yourself, and that sort of sucked if you were less than reliable.

I told myself that if I didn’t care, this wouldn’t have hurt so much—surely that proved I was alive and human and all those touchy-feely things, for once and for all. But that wasn’t a relief, not when I felt like a skyscraper with dynamite on every floor.

That’s why I reached into the tub and turned on the water: so that I would drown out my sobs, so that when I grabbed the razor blade I’d hidden in the box of tampons and drew it over my skin like a violin’s bow, no one would hear the song of my shame.

This past summer, my mother ran out of sugar and drove to the local convenience store mid-recipe, leaving us alone for twenty minutes—which is not that long a period of time, you’d think. But it was long enough to start a fight with you about which TV show we should watch; it was long enough to yell There’s a reason Mom wishes you were dead; it was long enough to watch your face crumple and feel my conscience kick in.

“Wiki,” I’d said, “I didn’t really mean it.”

“Just shut up, Amelia—”

“Stop being such a baby—”

“Well, you stop being such a dickhead!”

That word, on your lips—it was enough to stop me in my tracks. “Where did you hear that?”

“From you, you stupid jerk,” you said.

Just then, a bird smacked into the window so loudly that we both jumped.

“What was that?” you asked, standing on the couch cushions to get a better look.

I climbed up next to you, careful, because I always had to be. The bird was little and brown, a swallow or a sparrow, I could never tell the difference. It was sprawled on the grass.

“Is it dead?” you asked.

“Well, how would I know that?”

“Don’t you think we ought to check?”

So we went outside and trudged halfway around the house. Big surprise, the bird was still exactly where it had been moments before. I squatted down and tried to see if its chest was moving at all.

Nada.

“We need to bury it,” you said soberly. “We can’t just leave it out here.”

“Why? Things die all the time in nature—”

“But this one was our fault. The bird probably heard us yelling and that’s why it flew into the window.”

I highly doubted that the bird heard us at all, but I wasn’t going to argue with you.

“Where’s the shovel?” you asked.

“I don’t know.” I thought for a moment. “Hang on,” I said, and I ran into the house. I took the big metal mixing spoon Mom had in her bowl and carried it outside. There was still batter on it, but maybe that would be okay, like sending Egyptian mummies off to the afterlife with food and gold and their pets.

I dug a small hole in the ground about six inches away from where the bird was. I didn’t want to touch it—that totally creeped me out—so I sort of flicked it into the hole with the edge of the spoon. “Now what?” I asked, looking up at you.

“Now we have to say a prayer,” you said.

“Like a Hail Mary? What makes you think the bird was Catholic?”

“We could sing a Christmas carol,” you suggested. “That’s not really religious. It’s just pretty.”

“How about instead we say something nice about birds?”

You agreed to that. “They come in rainbow colors,” you said.

“They fly well,” I added. Until about ten minutes ago, anyway. “And they make nice music.”

“And birds remind me of chicken and chicken tastes really great,” you said.

“Okay, that’s good enough.” I shoveled the soil on top of the dead bird, and then you crouched down and made a pattern on the top with bits of grass, like sprinkles on a cake. We walked side by side into the house again.

“Amelia? You can watch whatever you want on TV.”

I turned to you. “I don’t wish you were dead,” I admitted.

When we sat down on the couch again, you curled up against my side, like you used to when you were a toddler.

What I wanted to say to you, but didn’t, was this: Don’t use me as your model. I’m the last person you should look up to.

For weeks after we buried that dumb bird, every time it rained, I would not sit near that window. Even now, I wouldn’t walk near that part of the yard. I was afraid that I’d hear something crunch and I’d look down and find the broken bones of the skeleton, the brittle wings, the chiseled beak. I was smart enough to look away, so that I’d never have to see what might surface.

People always want to know what it feels like, so I’ll tell you: there’s a sting when you first slice, and then your heart speeds up when you see the blood, because you know you’ve done something you shouldn’t have, and yet you’ve gotten away with it. Then you sort of go into a trance, because it’s truly dazzling—that bright red line, like a highway route on a map that you want to follow to see where it leads. And—God—the sweet release, that’s the best way I can describe it, kind of like a balloon that’s tied to a little kid’s hand, which somehow breaks free and floats into the sky. You just know that balloon is thinking, Ha, I don’t belong to you after all; and at the same time, Do they have any idea how beautiful the view is from up here? And then the balloon remembers, after the fact, that it has a wicked fear of heights.

When reality kicks in, you grab some toilet paper or a paper towel (better than a washcloth, because the stains don’t ever come out 100 percent) and you press hard against the cut. You can feel your embarrassment; it’s a backbeat underneath your pulse. Whatever relief there was a minute ago congeals, like cold gravy, into a fist in the pit of your stomach. You literally make yourself sick, because you promised yourself last time would be the last time, and once again, you’ve let yourself down. So you hide the evidence of your weakness under layers of clothes long enough to cover the cuts, even if it’s summertime and no one is wearing jeans or long sleeves. You throw the bloody tissues into the toilet and watch the water go pink before you flush them into oblivion, and you wish it was really that easy.

I once saw a movie where a girl got her throat slashed, and instead of a scream, there was this low sigh—like it didn’t hurt, like it was just a chance to finally let go. I knew that feeling was coming, so I waited a moment between my second and third cuts. I watched the blood welling on my thigh and I tried to hold off as long as I could before I drew the razor across the skin again.

“Amelia?”

Your voice. I looked up, panicked. “What are you doing in here?” I said, folding my legs up, so that you couldn’t get a better glimpse of what you’d probably already seen. “Haven’t you ever heard of privacy?”

You were teetering on your crutches. “I just wanted to get my toothbrush, and the door wasn’t locked.”

“Yes it was,” I argued. But maybe I was wrong? I had been so focused on calling Adam, maybe I had forgotten. I fixed my meanest stare on you. “Get out!” I yelled.

You hobbled back to our room, leaving the door open. I quickly lowered my legs and pressed a wad of toilet paper against the cuts I’d made. Usually I waited until they stopped bleeding before I left the bathroom, but I just pulled up my jeans with that strategically placed padding and went into our bedroom. I stared at you, practically daring you to say something to me about what you’d seen, so that I could scream at you again, but you were sitting on the bed, reading. You didn’t say anything to me at all.

I always hated when my scars started to fade, because as long as I could still see them, I knew why I was hurting. I wondered if you felt the same way, once your bones healed.

I lay back on my pillows. My thigh throbbed.

“Amelia?” you said. “Will you tuck me in?”

“Where’s Mom and Dad?” You didn’t really have to answer that—even if they were physically downstairs, they were so far removed from us that they might as well have been on the moon.

I could still remember the first night I hadn’t needed my parents to tuck me in. I might have been about your age, in fact. Before that night, there had been a routine—lamps off, sheets cozied tight, kiss on the forehead—and monsters in the drawers of my desk and hiding behind books on the shelf. And then one day, I just put down the book I’d been reading and closed my eyes. Had my parents been proud of this newly self-sufficient kid? Or had they felt like they’d lost something they couldn’t even name?

“Well, did you brush your teeth?” I asked, but then I remembered you had been trying to do just that when I was busy cutting. “Oh, forget your teeth. One night won’t make a difference.” I got out of bed and awkwardly leaned over yours. “Good night,” I said, and then I bobbed down like a pelican, fishing, and pecked your forehead.

“Mom tells me a story.”

“Then get Mom to tuck you in,” I said, throwing myself back on my own mattress. “I don’t have any stories.”

You were quiet for a second. “We could make one up together.”

“Whatever floats your boat,” I sighed.

“Once upon a time there were two sisters. One of them was really, really strong, and one of them wasn’t.” You looked at me. “Your turn.”

I rolled my eyes. “The strong sister went outside into the rain and realized the reason she was strong was because she was made out of iron, but it was raining and she rusted. The end.”

“No, because the sister who wasn’t strong went outside when it was raining, and hugged her really tight until the sun came out again.”

When we were little, we’d sometimes sleep in the same bed. It never started out that way, but in the middle of the night I’d wake up and find you vined around me. You gravitated toward warmth; me, I liked to seek out the cold spots in my sheets. I’d spend hours trying to move away from you in the little twin bed, but I never even thought of moving you back into your own. Polar north can’t get away from a magnet; the magnet finds it, no matter what.

“Then what happened?” I whispered, but you had already drifted off to sleep, and I was left to dream my own ending.

Sean

By unspoken arrangement, I slept on the couch that night. Except “sleep” was too optimistic an outcome. I basically tossed and turned. The one time I did nod off, I had a nightmare that I was on the witness stand and looked at Charlotte, and when I started to respond to Guy Booker’s question, black gnats poured out of my mouth.

Whatever wall Charlotte and I had broken down last night had been reconstructed twice as high and twice as thick. It was a strange thing, to still be in love with your wife and to not know if you liked her. What would happen when this was all over? Could you forgive someone if she hurt you and the people you love, if she truly believed she was only trying to help?

I had filed for divorce, but that wasn’t what I really wanted. What I really wanted was for all of us to go back two years, and start over.

Had I ever really told her that?

I threw off the blanket and sat up, rubbing my hands down my face. Wearing just my boxers and a police department tee, I padded upstairs and slipped into our bedroom. I sat down on the bed. “Charlotte,” I whispered, but there was no response.

I touched the bundle of quilts, only to realize it was a pillow trapped under the sheets. “Charlotte?” I said out loud. The bathroom door was wide open; I turned on the light, but she wasn’t inside. Starting to worry—Was she just as upset as I was about the trial? Had she been sleepwalking?—I walked down the hallway, checking your bathroom, the guest room, the narrow staircase that led to the attic.

The last door was your room. I stepped inside and immediately saw her. Charlotte was curled on your bed, her arm wrapped tight around you. Even in her sleep, she wasn’t willing to let you go.

I touched your hair, and then your mother’s. I brushed Amelia’s cheek. And then I lay down on the throw rug on the floor and pillowed my head on my arm. Go figure: with all of us together again, I fell asleep in a matter of minutes.

Marin

“Do you know what this is about?” I asked, as I hurried along the courthouse hallway beside Guy Booker.

“Your guess is as good as mine,” he said.

We had been called to chambers before the start of the second day of the trial. Being called to chambers, this early on, was not usually a good thing—particularly not if it was something Guy Booker didn’t know about, either. Whatever pressing issue Judge Gellar had to address most likely was not one I wanted to hear.

We were led in to find the judge sitting at his desk, his too-black hair a helmet. It reminded me of those old Superman action figures—you just knew that Superman’s coif never blew around in the wind when he flew, some marvel of physics and styling gel—and it was distracting enough for me not even to notice the second person in the room, who was sitting with her back to us.

“Counselors,” Judge Gellar said. “You both know Juliet Cooper, juror number six.”

The woman turned around. She was the one who—during voir dire—had been the target of Guy’s intrusive questions about abortion. Maybe the defense attorney’s hammering of Charlotte yesterday about the same issue had triggered a complaint. I stood up a little straighter, convinced that the reason the judge had convened us had little to do with me and much to do with Guy Booker’s questionable practice of the law.

“Ms. Cooper will be excused from the jury. Beginning immediately, the alternate juror will be rotated into the pool.”

No lawyer likes to have the jury change in the middle of a trial but neither do judges. If this woman was being excused, it must have been for a very good reason.

She was looking at Guy Booker, and very deliberately not looking at me. “I’m sorry,” she murmured. “I didn’t know I had a conflict of interest.”

Conflict of interest? I had assumed it was a health issue, some emergency that required her to fly to the bedside of a dying relative or go immediately for chemo. A conflict of interest meant that she knew something about my client or Guy’s—but surely she would have realized this during jury selection.

Apparently, Guy Booker felt the same way. “Is it possible to hear what the conflict is, exactly?”

“Ms. Cooper is related to one of the parties in this case,” Judge Gellar said, and he met my gaze. “You, Ms. Gates.”

I used to imagine that I saw my birth mother everywhere and just didn’t know it. I’d smile an extra moment longer at the lady who handed me my ticket at the movie theater; I’d make conversation about the weather with my bank teller. I’d hear the cultured voice of a receptionist at a rival firm and imagine that it was her; I’d bump into a lady in a cashmere coat in the lobby downstairs and stare at her face as I apologized. There were any number of people I could cross paths with who might be my mother; I could run into her dozens of times each day without ever knowing.

And now she was sitting across from me, in Judge Gellar’s chambers.

He and Guy Booker had left us alone for a few minutes. And to my surprise, even with almost thirty-six years’ worth of questions, the dam didn’t break down easily. I found myself staring at her hair—which was a frizzy red. All my life, I’d looked different from the other people in my family, and I had always assumed that I was a carbon copy of my birth mother. But I didn’t resemble her, not at all.

She was holding on to her purse with a death grip. “A month ago I got a phone call from the courthouse,” Juliet Cooper said. “Saying that they had some information for me. I thought something like this might happen one day.”

“So,” I said, but my voice was wheezy, dry. “How long have you known?”

“Only since yesterday. The clerk mailed me your card a week ago, but I couldn’t make myself open it. I wasn’t ready.” She looked up at me. Her eyes were brown. Did that mean my father’s had been blue, like mine? “It was what happened in court yesterday—all those questions about the mother wanting to get rid of her baby—that made me finally get up the nerve to do it.”

I felt as if I’d been pumped full of helium: surely, then, this meant that she hadn’t really wanted to give me up, just like Charlotte hadn’t really wanted to give up Willow.

“When I got to the end of the card, I saw your name, and realized I knew it already, from the trial.” She hesitated. “It’s a pretty unique name.”

“Yes.” What had you wanted to call me instead? Suzy, Margaret, Theresa?

“You’re very good,” Juliet Cooper said, shyly. “In court, I mean.”

There was three feet of space between us. Why wasn’t either of us crossing it? I had imagined this moment so many times, and it always ended with my mother holding me tight, as if she needed to make up for ever having let me go.

“Thank you,” I said. Here’s what I hadn’t realized: the mother you haven’t seen for almost thirty-six years isn’t your mother, she’s a stranger. Sharing DNA does not make you fast friends. This wasn’t a joyous reunion. It was just awkward.

Well, maybe she was as uncomfortable as I was; maybe she was afraid to overstep her bounds or assumed I held a grudge against her for giving me up in the first place. It was my job, then, to break the ice, wasn’t it? “I can’t believe that I spent all this time looking for you and you turned up on my jury,” I said, smiling. “It’s a small world.”

“Very,” she agreed, and went dead silent again.

“I knew I liked you during voir dire,” I said, trying to make a joke, but it fell flat. And then I remembered something else Juliet Cooper had said during jury selection: She used to be a stay-at-home mother. She’d only gone back to work when her children went to high school. “You have kids. Other kids.”

She nodded. “Two girls.”

For an only child, that was remarkable: Not only had I found my birth mother but I had gained siblings. “I have sisters,” I said out loud.

At that, something shuttered in Juliet Cooper’s eyes. “They are not your sisters.”

“I’m sorry. I didn’t mean—”

“I was going to write you a letter. I was going to send it to the Hillsborough court and ask them to forward it to you,” she said. “Listening to Charlotte O’Keefe brought it all back for me: there are just some babies who are better off not being born.” Juliet stood up abruptly. “I was going to write you a letter,” she repeated, “and ask you not to contact me again.”

And just like that, my birth mother abandoned me for the second time in my life.

When you’re adopted, you may have the happiest life in the world, but there’s always a part of you that wonders if you’d been cuter, quieter, an easy delivery—well, maybe then your birth mom wouldn’t have given you up. It’s silly, of course—the decision to give a child up for adoption is made months in advance—but that doesn’t keep you from thinking it all the same.

I had gotten straight A’s in college. I’d graduated at the top of my law school class. I did this, of course, to make my family proud of me—but I didn’t specify which family I was talking about. My adoptive parents, sure. But also my birth parents. I think there was always a hidden belief that if my birth mother stumbled across me and saw how smart I was, how successful, she couldn’t help but love me.

When in fact, she couldn’t help but leave me.

The door of the conference room opened, and Charlotte slipped inside. “There was a reporter in the ladies’ room. She came after me with a microphone while I was going into a—Marin? Have you been crying?”

I shook my head, although it was clear that I was. “Something in my eye.”

“Both of them?”

I stood up. “Let’s go,” I said brusquely, and I left her to follow in my wake.

Dr. Mark Rosenblad, who treated you at Children’s Hospital in Boston, was my next witness. I decided to shake myself off autopilot and give the performance of a lifetime for the juror who’d taken Juliet Cooper’s place, who happened to be a fortyish man with thick glasses and an overbite. He smiled at me as I directed all my questions about Rosenblad’s qualifications in his general direction.

With my luck, I’d lose the trial and have this guy ask me out on a date.

“You’re familiar with Willow, Dr. Rosenblad?” I said.

“I’ve treated her since she was six months old. She’s a great kid.”

“What type of OI does she have?”

“Type III—or progressively deforming OI.”

“What does that mean?”

“It’s the most severe form of OI that isn’t lethal. Children who have Type III will have hundreds of broken bones over the course of a lifetime—not just from contact but sometimes caused by rolling over in their sleep or reaching for something on a shelf. They often develop severe respiratory infections and complications because of the barrel shape of their rib cages. Often Type III kids have hearing loss or loose joints and poor muscle development. They’ll get severe scoliosis that requires spinal rodding or even having the vertebrae fused together—although that’s a tricky decision, because from that moment on, the child won’t grow any taller, and these kids have short stature to begin with. Other complications can include macrocephaly—fluid on the brain—cerebral hemorrhage caused by birth trauma, brittle teeth, and for some Type IIIs, basilar invagination—the second vertebra moves upward and cuts off the opening in the skull where the spinal cord passes through to the brain, causing dizziness, headache, periods of confusion, numbness, or even death.”

“Can you tell us what the next ten years will be like for Willow?” I asked.

“Like many kids her age with Type III OI, she’s been on pamidronate since she was a baby. It’s improved the quality of her life significantly—prior to bisphosphonates, Type III kids would rarely walk and would have been wheelchair-bound. Instead of having several hundred breaks in her life, thanks to the pamidronate, she may have only a hundred—we’re not sure. Some of the research that’s coming back now through teenagers who began getting infusions as babies, like Willow, shows that the bones—when they do break— aren’t breaking along normal fracture patterns, and that makes them more difficult to treat. The bone’s getting denser because of the infusions, but it’s still imperfect bone. There’s also some evidence of jawbone abnormalities, but it’s unclear whether that’s related to the pamidronate or just part of the dentinogenesis that goes with OI. So some of these complications might occur,” Dr. Rosenblad said. “In addition, she’ll still have breaks, and surgeries to repair them. She was recently rodded in one thigh; I imagine the other will follow suit. Eventually she’ll have spinal surgery. She’s had pneumonia annually. Virtually all Type IIIs develop some sort of chest wall abnormalities, vertical collapse, and kyphoscoliosis, all of which lead to lung disease and cardiopulmonary distress. A number of individuals with Type III die due to respiratory or neurological complications, but with any luck, Willow will be one of our success stories—and will go into adulthood and live a fully functional and important life.”

For a moment, I just stared at Dr. Rosenblad. Having met you, and talked to you, and even seen you struggling to wheel yourself up an incline or reach for something on a counter that was too tall, I found it hard to conceive that all these medical nightmares awaited you. It was, of course, the hook Bob Ramirez and I had planned to hang this lawsuit on from the get-go, but even I had come to take your life for granted.

“If Willow does survive into adulthood, will she be able to take care of herself?”

I couldn’t look at Charlotte while I asked this; I didn’t think I could stand to see her face at the use of if instead of when.

“She’s going to need someone to take care of her, to some extent, no matter how independent she becomes. There are always going to be breaks and hospitalizations and physical therapy. Holding down a job will be difficult.”

“Beyond the physical challenges,” I asked, “will there be emotional challenges as well?”

“Yes,” Dr. Rosenblad said. “Kids with OI often have anxiety issues, because of the worry and avoidance behavior they exhibit to keep from suffering a break. They sometimes develop post-traumatic stress disorder after particularly severe fractures. In addition, Willow’s already started to notice she’s different from other kids and limited because of her OI. As kids with OI grow up, they want to be independent—but they can’t be as functionally independent as able-bodied teens. The struggle can cause kids with OI to become introverted, depressed, perhaps even suicidal.”

When I turned around, I saw Charlotte. Her face was buried in her hands.

Maybe a mother wasn’t what she seemed to be on the surface. Maybe Charlotte had sued Piper Reece because she loved Willow too much to let her go. Maybe my birth mother let me go because she knew she couldn’t love me.

“In the six years you’ve treated Willow, have you gotten to know Charlotte O’Keefe?”

“Yes,” the doctor replied. “Charlotte’s incredibly attuned to her daughter. She’s almost got a sixth sense when it comes to Willow’s level of discomfort, and for making sure steps are taken before it gets out of hand.” He glanced at the jury. “Remember Shirley MacLaine in Terms of Endearment? That’s Charlotte. Sometimes she’s so stubborn I want to sock her—but that’s because I’m the one she’s standing up to.”

I sat back down, opening the questioning to Guy Booker. “You’ve been treating this child since she was six months old, correct?”

“Yes. I was working at Shriners in Omaha at the time, and Willow was part of our pamidronate trials there. When I moved to Children’s in Boston, it made more sense to treat her closer to home.”

“Now how often do you see her, Dr. Rosenblad?”

“Twice a year, unless there’s a break in between. And let’s just say I’ve never seen Willow only twice a year.”

“How long have you been using pamidronate to treat children with OI?”

“Since the early nineties.”

“And you said that, prior to the advent of pamidronate for OI, these children had a much more limited life in terms of mobility, correct?”

“Absolutely.”

“So would you say that the medical technology in your field has increased Willow’s health potential?”

“Dramatically,” Dr. Rosenblad said. “She’s able to do things now that kids with OI couldn’t do fifteen years ago.”

“So if this trial were taking place fifteen years ago, the picture you’d be painting for us of Willow’s life might be even more grim, wouldn’t you agree?”

Dr. Rosenblad nodded. “That’s correct.”

“Given that we live in America, where medical research is blooming in laboratories and hospitals like yours on a daily basis, isn’t it likely that Willow might see even more medical advances in her lifetime?”

“Objection,” I said. “Speculative.”

“He’s an expert in his field, Judge,” Booker countered.

“He can give his opinion,” Judge Gellar said, “based on his knowledge as to what medical research is currently being done.”

“It’s possible,” Dr. Rosenblad replied. “But like I also pointed out, the wonder drugs that we thought bisphosphonates were might, over the long term, reveal some other problems we hadn’t counted on for OI patients. We just don’t know yet.”

“Conceivably, however, Willow could grow to adulthood?” Booker asked.

“Absolutely.”

“Could she fall in love?”

“Of course.”

“Could she have a baby?”

“Possibly.”

“Could she work outside the home?”

“Yes.”

“Could she live independently of her parents?”

“Maybe,” Dr. Rosenblad said.

Guy Booker spread his hands across the railing of the jury box. “Doctor, you treat illness, don’t you?”

“Sure.”

“Would you ever treat a broken finger by amputating the arm?”

“That would be a bit extreme.”

“Isn’t it extreme to treat OI then by preventing the patient from being born?”

“Objection,” I called out.

“Sustained.” The judge glared at Guy Booker. “I won’t have my courtroom turned into a pro-life rally, Counselor.”

“I’ll rephrase. Have you ever encountered a parent whose child is diagnosed with OI in utero who chooses to terminate the pregnancy?”

Rosenblad nodded. “Yes, often in cases where you’re talking about the lethal form of OI, Type II.”

“What about the severe form?”

“Objection,” I said. “What does this have to do with the plaintiff?”

“I want to hear this,” Judge Gellar said. “You may answer the question, Doctor.”

Rosenblad stepped through the minefield of his response. “Terminating a wanted pregnancy is no one’s first choice,” he said, “but when faced with a fetus who will become a severely disabled child, different families have different levels of tolerance. Some families know they’ll be able to provide enough support for a child with disabilities, some are smart enough to know, in advance, they won’t.”

“Doctor,” Booker said, “would you call Willow O’Keefe’s birth a wrongful one?”

I felt something at my side and realized that Charlotte was trembling.

“I am not in a position to make that decision,” Rosenblad said. “I’m just the physician.”

“My point exactly,” Booker answered.

Piper

I had not seen my ultrasound technician Janine Weissbach since she left my practice four years ago and went to work at a hospital in Chicago. Her hair, which had been blond, was now a sleek chestnut, and there were fine lines bracketing her mouth. I wondered if I looked the same to her, or if betrayal had aged me beyond recognition.

Janine had been allergic to nuts, and once there had been a minor war between her and a nurse on staff who’d brewed hazelnut coffee. Janine broke out in hives just from the smell that permeated our little lounge; the nurse swore she didn’t realize that liquefied nuts counted when it came to allergy; Janine asked how she’d ever passed her nursing exam. In fact, the brouhaha had been the biggest upset in my practice…until, of course, this.

“How is it that you came to know the plaintiff in this case?” Charlotte’s lawyer asked.

Janine leaned closer to the microphone on the witness stand. She used to sing karaoke, I remembered, at a local nightclub. She had referred to herself as pathologically single. Now, though, she wore a wedding band.

People changed. Even the people you thought you knew as well as you knew yourself.

“She was a patient at the office where I was working,” Janine said. “Piper Reece’s ob-gyn practice.”

“You’re employed by the defendant?”

“I was for three years, but now I work at Northwestern Memorial Hospital.”

The lawyer was staring off at a wall, as if she wasn’t even listening. “Ms. Gates,” the judge prompted.

“Sorry,” she said, snapping to attention. “You’re employed by the defendant?”

“You just asked me that.”

“Right. Um, can you tell us the circumstances under which you met Charlotte O’Keefe?”

“She came in for an eighteen-week ultrasound.”

“Who else was there?”

“Her husband,” Janine said.

“Was the defendant there?”

For the first time, Janine met my eye. “Not at first. The way we did it, I’d perform the ultrasound and discuss it with her; and she’d read the results and talk to the patient.”

“What happened during Charlotte O’Keefe’s ultrasound, Ms. Weissbach?”

“Piper had told me to be on the lookout for anything that might signify Down syndrome. The patient’s quad screen had shown a slightly elevated risk. I was excited to be working with a new machine—it had only just arrived, and was state of the art. I got Mrs. O’Keefe settled on the table, put some gel onto her abdomen, and then moved the transducer around to get several clear views of the fetus.”

“What did you see?” the lawyer asked.

“The femurs were measuring on the small side, which can sometimes be a flag for Down syndrome, but none of the other indicators were present.”

“Anything else?”

“Yes,” Janine said. “Some of the images were incredibly clear. Particularly the one of the fetal brain.”

“Did you mention these findings to the defendant?”

“Yes. She said that the femur wasn’t off the charts, that it could simply be because the mother was short,” Janine answered.

“What about the clarity of the images? Did the defendant have anything to say about that?”

“No,” Janine said. “She didn’t.”

The night I’d driven Charlotte home from her twenty-seven-week ultrasound, the one with all the broken bones visible, I’d stopped being her friend and started being a doctor. I sat at the kitchen table and used medical terminology, which almost acted like a sedative itself: the pain in Charlotte’s and Sean’s eyes dulled as I heaped them with information they could not understand. I talked to them about the physician I’d already called for a consultation.

At one point, Amelia had flitted into the kitchen. Charlotte hastily wiped her eyes. “Hey, sweetie,” she said.

“I came to say good night to the baby,” Amelia said, and she ran up to Charlotte where she sat and wrapped her arms as best as she could around her mother’s belly.

Charlotte made a tiny sound, a mewling. “Not so tight,” she managed, and I knew what she was thinking: had this eager love broken some of your bones?

“But I want her to come out,” Amelia said. “I’m sick of waiting.”

Charlotte stood up. “I think I might go lie down, too.” She held out her hand for Amelia, and they walked out of the kitchen.

Sean sank into the seat she’d vacated. “It’s me, right?” He looked up at me, haunted. “I’m the reason the baby’s like this.”

“No—”

“Charlotte had one kid who was perfectly fine,” he said. “Do the math.”

“This is probably a spontaneous mutation. There’s nothing you could have done to prevent it.” I couldn’t have prevented it, either. But that didn’t keep me from feeling guilty, just like Sean. “You have to take care of her, because she can’t fall apart right now. Don’t let her look this up on the Internet before you see the doctor tomorrow; don’t tell her you’re worried.”

“I can’t lie,” Sean said.

“Well, you will, if you love her.”

Now, all these years later, I wondered why I could not forgive Charlotte for following this very same advice.

I didn’t like Guy Booker, but then again, when you choose malpractice insurance providers, you’re not going for the folks you want to have over for Christmas dinner. He was good at making someone squirm on the witness stand, like an insect being pinned by a collector who wanted to scrutinize it more closely. “Ms. Weissbach,” Booker said, standing up to do his cross-examination, “have you ever seen another fetus that had a similar finding in the measurement of the femur?”

“Of course.”

“Do you happen to know the outcome?”

Charlotte’s lawyer stood up. “Objection, Your Honor. The witness is just a technologist, not a physician.”

“She sees this every day,” Booker countered. “She’s specially trained to read sonograms.”

“Sustained.”

“Well,” Janine said, miffed. “For your information, it’s not so easy to read the results of an ultrasound. I may just be a technologist, but I’m also supposed to point out things that might be problematic.” She jerked her chin toward me. “Piper Reece was my boss. I was just doing my job.”

She did not say anything more, but I could hear it all the same: Unlike you.

Charlotte

Something was wrong with my lawyer. She was fidgeting; she kept missing questions and forgetting answers. It got me wondering: Was doubt contagious? Had Marin sat next to me all day while I fought the urge to stand up and put an end to all this, and then awakened this morning with the same gut instincts?

She had called in a witness I did not know—Dr. Thurber, who was British but had become the head of radiology at Lucile Packard Children’s Hospital at Stanford before moving to Shriners in Omaha and applying his knowledge as a radiologist to OI kids. According to the endless list of credentials Marin had led him through, Dr. Thurber had read thousands of ultrasounds during his career, had lectured throughout the world, and donated two weeks of his vacation every year to provide care to expectant mothers in impoverished countries.

Basically, he was a saint. A really smart one.

“Dr. Thurber,” Marin said, “for those of us who aren’t familiar with ultrasounds, can you explain the technology?”

“It’s a diagnostic tool, in terms of obstetrics,” the radiologist said. “The equipment is a real-time scanner. Sound waves get emitted from a transducer, which is placed against the mother’s abdomen and moved around to reflect the contents of the uterus. The image gets projected onto a monitor—a sonogram.”

“What are ultrasounds used for?”

“To diagnose and confirm pregnancy, to assess fetal heartbeat and fetal malformations, to measure the fetus in order to assess the gestational age and growth, to see the location of the placenta, to determine the amount of amniotic fluid—among other things.”

“When are ultrasounds traditionally performed during pregnancy?” Marin asked.

“There’s no hard-and-fast rule, but sometimes scans can be done at about seven weeks to confirm pregnancy and rule out ectopic or molar pregnancies. Most women have at least one ultrasound performed between eighteen and twenty weeks.”

“What happens during that ultrasound?”

“By then, the fetus is large enough to check out the anatomy and to look for congenital malformations,” Dr. Thurber said. “Certain bones will be measured, to make sure the baby is the right size based on the date of conception. They’ll make sure organs are in the right place, and that the spine’s intact. Basically, it’s a confirmation that everything’s where it’s supposed to be. And of course, you get to go home with a picture that stays taped to your fridge for the next six months.”

There were a few laughs on the jury. Had I had a picture of you, from your ultrasound? I couldn’t remember. When I think back to that day, I only feel this great tidal wash of relief, from the moment Piper told me you were healthy.

“Dr. Thurber,” Marin asked, “did you have an opportunity to review the eighteen-week ultrasound that was performed on Charlotte O’Keefe?”

“I did.”

“And what did you see?”

He glanced at the jury. “Based on the ultrasound, there was definite cause for concern. Normally when you do an ultrasound, you’re looking at the brain through the skull, so it’s usually a little fuzzy, a little bit muddy and gray, because of reverberation artifacts from the side of the skull that the ultrasound beam first hits. In Mrs. O’Keefe’s sonogram, however, the intracranial contents were crystal clear—even that near field of the cerebral hemisphere, which is normally obscured. This suggests a demineralized calvarium. There are several conditions in which the skull presents undermineralized, including skeletal dysplasia, and OI. One then has the obligation to look at the long bones, and in fact femur length is a part of every obstetric ultrasound. In Mrs. O’Keefe’s case, the femur was also measuring a bit short. The combination of the short femur and the demineralized skull is strongly suggestive of osteogenesis imperfecta.” He let the words hang in the courtroom. “In fact, had the technologist pushed down on Mrs. O’Keefe’s belly as she was doing the ultrasound, she would have been able to watch the screen and see the skull of the fetus being squashed out of shape.”

I folded my hands over my stomach, as if you were still inside.

“If Mrs. O’Keefe had been your patient, Doctor, what would you have done?”

“I would have taken more images of the chest—looking for rib fractures. I would have measured all the other long bones to confirm that this was a generalized short-bone condition. And at the very least I’d have referred the case to a center with more experience.”

Marin nodded. “What if I told you that Mrs. O’Keefe’s obstetrician did none of those things?”

“Then,” Dr. Thurber said, “I’d say that physician made a very big mistake.”

“Nothing further,” Marin said, and she slipped into the seat beside me. She immediately let out a heavy sigh.

“What’s the matter?” I whispered. “He’s very good.”

“Did it ever occur to you that you’re not the only one with problems?” Marin snapped.

Guy Booker got up to cross-examine the radiologist. “They say hindsight is twenty-twenty, don’t they, Dr. Thurber?”

“So I’ve heard.”

“How long have you testified as an expert witness?”

“For ten years,” the doctor said.

“I’m guessing you don’t do this for free?”

“No, I’m paid, like all expert witnesses,” Thurber replied.

Booker looked at the jury. “Right. There sure seems to be a lot of money flying around these days, isn’t there?”

“Objection,” Marin said. “Does he really expect the witness to answer his rhetorical questions?”

“Withdrawn. Doctor, isn’t it true that osteogenesis imperfecta is very rare?”

“Yes.”

“So a small-town OB, for example, might go through her entire professional life without ever seeing a case?”

“That’s true,” Thurber answered.

“Isn’t it fair to say that only a specialist would have been looking for OI on an ultrasound?”

“There is the old medical saying about hearing hoofbeats and assuming it’s a horse instead of a zebra,” Thurber agreed, “but any trained obstetrician should be able to look at an ultrasound and spot red flags. She might not be able to identify what they signify, but she would know them for their abnormality, and would recognize that the patient’s care needs to be taken to the next level.”

“Is there any condition other than osteogenesis imperfecta that can give you such a clear image of the near field of the brain during an ultrasound?”

“The lethal form of congenital hypophosphatasia, but it’s extremely rare and it still wouldn’t have changed the need for the patient to be referred to a tertiary-care center.”

“Dr. Thurber,” Booker said, “do you ever get a particularly clear image of intracranial contents of the skull…on a healthy baby?”

“Occasionally. If the plane of the ultrasound on a particular image happens by chance to go through one of the normal cranial sutures, instead of bone, the interior of the brain will be shown clearly. However, we take multiple pictures of the brain looking at different intracranial structures, and the sutures are very thin. It would be virtually impossible to see multiple pictures of the brain for multiple projections where the transducer manages to hit a suture every single time. If I saw one image that showed the near field of brain very clearly but the other images did not, I would assume that single image had been taken through a cranial suture. In this case, however, all of the images of the brain show the intracranial contents unusually well.”

“How about that femur length? Have you ever measured a short femur during an eighteen-week ultrasound and then seen a perfectly healthy baby delivered?”

“Yes. Sometimes the technologists’ measurement can be off by a hair because the fetus is moving around or in an odd position. They measure two or three times and take the longest axis, but even being a whisker off at eighteen weeks—we’re talking millimeters—can drop the percentile significantly. Many times when we see a borderline-short femur length, it’s just undermeasured.”

Booker walked toward him. “As useful as ultrasound technology is, it’s not an exact science, is it? Certain images might be clearer than others?”

“The clarity with which we see all structures in the fetus is variable, yes. It depends on many things—the size of the mother, the position of the fetus. There’s a continuum, really. On any given day we might not be able to see them well, or conversely we might be able to see everything clearly.”

“At an eighteen-week ultrasound, Doctor, can you definitively say that a child is going to have Type III OI?”

“You can tell that there’s something wrong skeletally. You can see indicators—like the ones that were in Charlotte O’Keefe’s file. As the gestational age increases, if you see broken bones, you can generally guess that the fetus has Type III OI.”

“Doctor, if Charlotte O’Keefe had been your patient, and you’d seen the results of her eighteen-week ultrasound, and there were no broken bones, you would have recommended she have follow-up care?”

“Based on the short femur length and demineralized calvarium? Absolutely.”

“And once you saw broken bones on a subsequent ultrasound, would you have done what Piper Reece did: immediately refer Mrs. O’Keefe to a maternal-fetal-medicine practitioner at a tertiary-care center?”

“Yes.”

“But would you have conclusively diagnosed Mrs. O’Keefe’s fetus with OI at eighteen weeks, based solely on that first ultrasound?”

He hesitated. “Well,” Thurber said. “No.”

Amelia

Sometimes I wonder what really constitutes an “emergency.” I mean, every teacher in my school knew about the trial and the fact that both of my parents were not only in it but squaring off against each other. The whole state knew, and maybe even the whole country, thanks to the newspaper and television coverage. Surely even if they thought my mother was insane or moneygrubbing, they felt a smidgen of sympathy for me, being trapped in the middle? And yet, I still got yelled at in math for not paying attention. I had a huge English test tomorrow, vocabulary, on ninety words that I was most likely never going to use in my life.

To that end, I was making flash cards for myself. Hypersensitive, I wrote. Too too too sensitive. But wasn’t that the point? If you were sensitive, weren’t you bound to take things too seriously in the first place?

Trepidation: fear. Use it in a sentence: I have trepidations about taking this stupid test.

“Amelia!”

I heard you calling, but I also knew I didn’t have to answer. After all, my mother—or maybe Marin—was paying that nurse who smelled like mothballs to watch over you. This was the second day she’d been here when I got off the bus, and to tell you the truth, I wasn’t impressed. She was watching General Hospital when she should have been playing with you.

“Amelia!” you yelled, louder this time.

I screeched the chair back from my desk and thundered downstairs. “What?” I demanded. “I’m trying to study.”

Then I saw it: Nurse Ratched had barfed all over the floor.

She was leaning against the wall, her face the color of Silly Putty. “I think I ought to go home…,” she wheezed.

Well, duh. I didn’t want to catch the bubonic plague.

“Do you think you can watch Willow till your mother gets back?” she asked.

As if I hadn’t been doing just that my whole life. “Sure.” I hesitated. “You are going to clean it up, first, right?”

“Amelia!” Willow hissed. “She’s sick!”

“Well, I’m not going to do it,” I whispered, but the nurse was already heading to the kitchen to mop up her mess.

“I still have to study,” I said, after we were left alone. “Let me go up and get my notebook and flash cards.”

“No, I’ll go upstairs instead,” you answered. “I kind of want to lie down.”

So I carried you—you were that light—and settled you on the bed with your crutches next to you. You picked up your latest book to start reading.

Scrutinize: to observe carefully.

Stature: the full height of a human.

I glanced at you over my shoulder. You were the size of a three-year-old, even though you were six and a half now. I wondered how small you’d stay. I thought about how there are kinds of goldfish that get bigger when you put them in large ponds and wondered if that would help: what if, instead of sitting in this bed, in this stupid house, I showed you the whole wide world?

“I could quiz you,” you said.

“Thanks, but I’m not ready yet. Maybe later.”

“Did you know Kermit the Frog is left-handed?” you asked.

“No.”

Dissipated: dissolved, faded away.

Elude: to escape from. I wish.

“Do you know how big a grave is when it’s dug?”

“Willow,” I said, “I’m trying to study here. Could you just shut up?”

“Seven feet, eight inches, by three feet, two inches, by six feet,” you whispered.

“Willow!”

You sat up. “I’m going to the bathroom.”

“Great. Don’t get lost,” I snapped. I watched you carefully lever your crutches so that you could hop your way off the bed. Usually Mom walked you to the bathroom—or, really, hovered—and then privacy kicked in and you booted her out and closed the door. “Do you need a hand?” I asked.

“Nope, just some collagen,” you said, and I almost cracked a smile.

A moment later, I heard the bathroom door lock. Scrupulous, devout, annihilate. Lethargic, lethal, subside. The world would be a much easier place if, instead of handing over superstuffed syllables all the time, we just said what we really meant. Words got in the way. The things we felt the hardest—like what it was like to have a boy touch you as if you were made of light, or what it meant to be the only person in the room who wasn’t noticed—weren’t sentences; they were knots in the wood of our bodies, places where our blood flowed backward. If you asked me, not that anyone ever did, the only words worth saying were I’m sorry.

I made it through Lesson 13 and Lesson 14—devious, aghast, rustic—and glanced down at my watch. It was only three o’clock. “Wiki,” I said, “what time did Mom say she’d be home—” And then I remembered you weren’t there.

You hadn’t been, for a good fifteen or twenty minutes.

No one had to go to the bathroom that long.

My pulse started racing. Had I been so engrossed in learning the definition of arbitration that I hadn’t heard a telltale fall? I ran to the bathroom door and rattled the knob. “Willow? Are you okay?”

There was no answer.

Sometimes I wonder what really constitutes an emergency.

I lifted up my leg and used my foot to break down the door.

Sean

The soup that came out of the vending machine at the courthouse looked—and tasted—just like the coffee. It was my third cup today, and I still wasn’t quite sure what I was drinking.

I was sitting near the window of my hiding place—my biggest accomplishment on this, the second day of the trial. I had planned to sit in the lobby until Guy Booker needed me—but I hadn’t counted on the press. The ones who hadn’t squeezed into the courtroom figured out who I was quickly enough and swarmed, leaving me to back away muttering No comment.

I’d poked through the maze of the courthouse corridors, trying door-knobs until I found one that opened. I had no idea what this room was used for normally, but it was located almost directly above the courtroom where Charlotte was right now.

I didn’t really believe in ESP or any of that crap, but I hoped she could feel me up here. Even more, I hoped that was a good thing.

Here was my secret: in spite of the fact that I had defected to the other side, in spite of the fact that my marriage had crashed on the rocks, there was a part of me that wondered what would happen if Charlotte won.

With enough money, we could send you to a camp this summer, so that you could meet other kids like you.

With enough money, we could buy a new van, instead of repairing the one that was seven years old with spit and glue.

With enough money, we could pay off our credit card debt and the second mortgage we’d taken out after the health insurance bills escalated.

With enough money, I could take Charlotte away for a night and fall in love with her again.

I truly believed that the cost of success for us shouldn’t be the cost of failure for a good friend. But what if we hadn’t known Piper personally, only professionally? Would I have endorsed a case like that against a different doctor? Was it Piper’s involvement I objected to—or the whole lawsuit?

There were so many things we hadn’t been told:

How it feels when a rib breaks, when I’m doing nothing more than cradling you.

How much it hurts to see the look on your face when you watch your older sister skating.

How even the people in a position to help have to cause pain first: the doctors who reset your bones, the folks who mold your leg braces by letting you play in them and get blisters, so that they know what to fix.

How your bones were not the only things that would break. There would be hairline cracks we would not see for years in my finances, my future, my marriage.

Suddenly I wanted to hear your voice. I took out my cell phone and started to dial, only to hear a loud beep as the battery died. I stared down at the receiver. I could go out to the car and get the charger, but that would mean running the gauntlet again. While I was weighing the costs and the benefits, the door to my sanctuary opened, and a slice of noise from the hallway slipped inside, followed by Piper Reece.

“You’ll have to find your own hiding place,” I said, and she jumped.

“You scared me to death,” Piper said. “How did you know that’s what I was doing?”

“Because it’s why I’m here. Shouldn’t you be in court?”

“We took a recess.”

I hesitated, then figured I had nothing to lose. “How’s it going in there?”

Piper opened her mouth, as if she were going to reply, and then shut it. “I’ll let you get back to your phone call,” she murmured, her hand on the doorknob.

“It’s dead,” I said, and she turned around. “My phone.”

She folded her arms. “Remember when there were no cell phones? When we didn’t have to listen to everyone’s conversations?”

“Some things are better left private,” I said.

Piper met my gaze. “It’s awful in there,” she admitted. “The last witness was an actuary who gave estimates on the out-of-pocket cost for Willow’s care, and the grand total, based on her life expectancy.”

“What did he say?”

“Thirty thousand annually.”

“No,” I said. “I meant, how long will she live?”

Piper hesitated. “I don’t like thinking of Willow in terms of numbers. Like she’s already a statistic.”

“Piper.”

“There’s no reason she won’t have a normal life expectancy,” Piper said.

“But not a normal life,” I finished.

Piper leaned against the wall. I had not turned the lights on—I didn’t want anyone to know I was in here, after all—and in the shadows her face looked lined and tired. “Last night I dreamed about the first time we had you over for dinner—to meet Charlotte.”

I could recall that night like it was yesterday. I had gotten lost on the way to Piper’s house because I was so nervous. For obvious reasons, I’d never before been invited to someone’s house after giving her a speeding ticket; and I wouldn’t have gone at all, but the day before pulling Piper’s car over for doing fifty in a thirty-mile-an-hour zone, I’d gone to the house of my best friend—another cop—and found my girlfriend in his bed. I had nothing to lose when Piper called the department a week later and asked; it was impulsive and stupid and desperate.

When I got to Piper’s, and was introduced to Charlotte, she’d held out her hand for me to shake and a spark had caught between our palms, shocking us both. The two little girls had eaten in the living room while the adults sat at the table; Piper had just served me a slice of caramel-pecan torte that Charlotte had made. “What do you think?” Charlotte had asked.

The filling was still warm and sweet; crust dissolved on my tongue like a memory. “I think we should get married,” I said, and everyone laughed, but I was not entirely kidding.

We had been talking about our first kisses. Piper told a story about a boy who’d enticed her into the woods behind the jungle gym on the pretext that there was a unicorn behind an ash tree; Rob talked about being paid five bucks by a seventh-grade girl for a practice run. Charlotte hadn’t been kissed, it turned out, till she was eighteen. “I can’t believe that,” I said.

“What about you, Sean?” Rob asked.

“I can’t remember.” By then, I had lost sense of everything but Charlotte. I could have told you how many inches away from my leg hers was beneath the table. I could have told you how the curls of her hair caught the candlelight and held on to it. I could not remember my first kiss, but I could have told you Charlotte would be my last.

“Remember how we had Amelia and Emma in the living room,” Piper said now. “We were having such a good time no one thought to check on them?”

Suddenly I could see it—all of us crowded into the tiny downstairs bathroom, Rob yelling at his daughter, who had commandeered Amelia into helping her dump dry dog food into the toilet bowl.

Piper started to laugh. “Emma kept saying it was only a cupful.”

But it had soaked up the water and swollen to fill the bowl. It was amazing, in fact, how quickly it had gotten out of control.

Beside me, Piper’s laughter had turned the corner, and in that way emotion has of hopping boundaries, she was suddenly crying. “God, Sean. How did we get here?”

I stood awkwardly, and then after a moment I slipped an arm around her. “It’s okay.”

“No, it’s not,” Piper sobbed, and she buried her face against my shoulder. “I have never, ever in my life been the bad guy. But every time I walk into that courtroom, that’s exactly what I am.”

I had hugged Piper Reece before. It was what married couples did—you went to someone’s house and you handed over the obligatory bottle of wine and kissed the hostess on the cheek. Maybe distantly I was aware that Piper was taller than Charlotte, that she smelled of an unfamiliar perfume instead of Charlotte’s pear soap and vanilla extract. At any rate, the embrace was triangular: you connected at the cheek, and then your bodies angled away from each other.

But right now Piper was pressed against me, her tears hot against my neck. I could feel the curve and weight of her body. And I could tell the exact moment she became aware of mine.

And then she was kissing me, or maybe I was kissing her, and she tasted of cherries, and my eyes closed, and the moment they did, all I could see was Charlotte.

We both pushed away from each other, our eyes averted. Piper pressed her hands to her cheeks. I have never, ever in my life been the bad guy, she had said.

There is a first time for everything.

“I’m sorry,” I said, at the same time Piper began to speak.

“I shouldn’t have—”

“It didn’t happen,” I interrupted. “Let’s just say it didn’t happen, all right?”

Piper looked up at me sadly. “Just because you don’t want to see something, Sean, doesn’t mean it wasn’t there.”

I didn’t know if we were talking about this moment, or this lawsuit, or both. There were a thousand things I wanted to say to Piper, all of which began and ended with an apology, but what tumbled off my lips instead was this: “I love Charlotte,” I said. “I love my wife.”

“I know,” Piper whispered, “I did, too.”

Charlotte

The movie that had been filmed to show a day in your life was the last bit of evidence that Marin would offer to the jury. It was the emotional counterpart to the cold, hard facts the actuary had given, about what it costs in this country to have a disabled child. It felt like ages since the video crew had followed you around school, and to be honest, I had worried about the outcome. What if the jury looked at our daily routine and didn’t find it remarkably different from anyone else’s?

Marin had told me that it was her job to make sure the presentation came off in our favor, and as soon as the first images projected onto the courtroom screen, I realized I should not have worried. Editing is a marvelous thing.

It began with an image of your face, reflected in the windowpane you were peering through. You weren’t speaking, but you didn’t have to. There was a lifetime of longing in your eyes.

The view panned out the window, then, to watch your sister skating on the pond.

Then came the first few strains of a song as I knelt down to strap on your braces before school, because you could not reach them yourself. After a moment I recognized it: “I Hope You Dance.”

In the pocket of my jacket, my cell phone began to vibrate.

We were not allowed to have cell phones on in court, but I’d told Marin that I had to be reachable, just in case—and we’d compromised with this. I slipped my hand into my pocket and looked at the screen to see who was calling.

HOME, it read.

On the projector screen, you were in class, and kids were funneling around you like a school of fish, doing some kind of spider dance at circle time, while you sat immobile in your wheelchair.

“Marin,” I whispered.

“Not now.”

“Marin, my phone’s ringing—”

She leaned closer to me. “If you pick up that phone right now instead of watching this film, the jury will crucify you for being heartless.”

So I sat on my hands, getting more and more agitated. Maybe the jury thought it was because I couldn’t watch this. The phone would stop vibrating and then start a moment later. On the screen I watched you at physical therapy, walking forward toward the mat biting your lower lip. The phone vibrated again, and I made a small sound in the back of my throat.

What if you’d fallen? What if the nurse didn’t know what to do? What if it was something even worse than a simple break?

I could hear snuffling sounds behind me, purses being opened and rummaged through for Kleenex. I could see the jury riveted by your words, your elfin face.

The phone buzzed again, an electrical shock to my system. This time I slipped it out of my pocket to see the text message icon. I hid the receiver under the table and flipped it open.

WILLOW HURT—HELP

“I have to get out of here,” I whispered to Marin.

“In fifteen minutes…We absolutely cannot recess right now.”

I looked up at the screen again, my heart hammering. Hurt, how? Why wasn’t the nurse doing something?

You were sitting on the mat, your legs frogged. Above you a red ring dangled. You winced as you reached for it. Can we stop now?

Come on, Willow, I know you’re tougher than that…wrap your fingers around and give it a squeeze.

You tried, for Molly. But tears were streaming from your eyes, and the sound that came from you was a sharp, staccato burst. Please, Molly…can I stop?

The phone was vibrating again. I wrapped my hand around it.

And then I was on the mat with you, holding you in my arms, rocking you, and telling you that I would make it better.

If I had been more aware of what was happening in the courtroom, I would have noticed that every woman on the jury was crying, and some of the men. I would have seen the TV cameras in the back of the gallery that were recording for playback on that night’s news. I would have seen Judge Gellar close his eyes and shake his head. But instead, the moment the screen went to black, I bolted.

I could feel everyone watching me as I ran up the aisle and out the double doors, and they probably thought I was overcome with emotion or too fragile to look at you in Technicolor. The moment I shoved past the bailiffs I hit the redial button on my phone. “Amelia? What’s the matter?”

“She’s bleeding,” Amelia sobbed, hysterical. “There was blood all over the place and she wasn’t moving and—”

Suddenly, an unfamiliar voice was on the phone. “Is this Mrs. O’Keefe?”

“Yes?”

“I’m Hal Chen, one of the EMTs who—”

“What’s wrong with my daughter!”

“She’s lost a great deal of blood, that’s all we know right now. Can you meet us at Portsmouth Regional?”

I don’t know if I even said yes. I didn’t try to tell Marin. I just ran—across the lobby, out the courthouse doors. I pushed past the reporters, who were caught unawares, who pulled themselves together just in time to focus their cameras and point their microphones at the woman who was sprinting away from this trial, headed toward you.

Amelia